Seeking the Patient's Perspective: A Qualitative Assessment of EuroQol, COOP-WONCA Charts and MYMOP

A mixed-methods evaluation of complementary therapy services in palliative care: yoga and dance therapy

To inform service provision and future research, we evaluated two complementary therapy services: yoga classes and dance therapy [The Lebed Method (TLM)]. Both were run as 6-week group courses. Patients completed the Measure Yourself Concerns and Wellbeing questionnaire pre- and post-course. Mean change over time was calculated for patient-nominated concern and well-being scores. Qualitative data regarding factors affecting health other than the therapy and benefits of the service were analysed using content analysis. Eighteen patients participated (mean age 63.8 years; 16 female; 14 cancer diagnoses); 10 were doing yoga, five TLM, and three both yoga and TLM; 14 completed more than one assessed course. Patients' most prevalent concerns were: mobility/fitness (n= 20), breathing problems (n= 20), arm, shoulder and neck problems (n= 18), difficulty relaxing (n= 8), back/postural problems (n= 8), fear/anxiety (n= 5). Factors affecting patients' health other than the therapy were prevalent and predominantly negative (e.g. treatment side effects). Patients reported psycho-spiritual, physical and social benefits. Concern scores improved significantly (P < 0.001) for both therapies; improved well-being was clinically significant for yoga. Evaluations of group complementary therapy services are feasible, can be conducted effectively and have implications for future research. Yoga and TLM may be of benefit in this population.

How do we evaluate outcome in an integrative oncology program?

Integrative oncology focuses on the roles of complementary therapies to increase the effectiveness of conventional cancer treatment programs by improving defined outcomes such as symptom control, quality of life, rehabilitation, and prevention of recurrence. Implementation of integrative oncology programs should be based on the best evidence and must continually be evaluated to ensure quality, optimization of techniques, collection of new data, and cost-effectiveness. Useful domains that can be evaluated include symptom control, adherence to treatment protocols, quality of life, individual outcomes, prevention, rehabilitation, potential advantages of a whole-systems health approach, and economics of health services.

Use of the measure your medical outcome profile (MYMOP2) and W-BQ12 (Well-Being) outcomes measures to evaluate chiropractic treatment: an observational study

Background

The objective was to assess the use of the Measure Yourself Medical Outcome Profile (MYMOP2) and W-BQ12 well-being questionnaire for measuring clinical change associated with a course of chiropractic treatment.

Methods

Chiropractic care of the patients involved spinal manipulative therapy (SMT), mechanically assisted techniques, soft tissue therapy, and physiological therapeutic devices.

Outcome measures used were MYMOP2 and the Well-Being Questionnaire 12 (W-BQ12).

Results

Statistical and clinical significant changes were demonstrated with W-BQ12 and MYMOP2.

Conclusions

The study demonstrated that MYMOP2 was responsive to change and may be a useful instrument for assessing clinical changes among chiropractic patients who present with a variety of symptoms and clinical conditions.

Using Chinese version of MYMOP in Chinese medicine evaluation: validity, responsiveness and minimally important change

Background

Measure Yourself Medical Outcome Profile (MYMOP) is a patient generated outcome instrument applicable in the evaluation of both allopathic and complementary medicine treatment. This study aims to adapt MYMOP into Chinese, and to assess its validity, responsiveness and minimally important change values in a sample of patients using Chinese medicine (CM) services.

Methods

A Chinese version of MYMOP (CMYMOP) is developed by forward-backward-forward translation strategy, expert panel assessment and pilot testing amongst patients. 272 patients aged 18 or above with subjective symptoms in the past 2 weeks were recruited at a CM clinic, and were invited to complete a set of questionnaire containing CMYMOP and SF-36. Follow ups were performed at 2^nd and 4^th week after consultation, using the same set of questionnaire plus a global rating of change question. Criterion validity of CMYMOP was assessed by its correlation with SF-36 at baseline, and responsiveness was evaluated by calculating the Cohen effect size (ES) of change at two follow ups. Minimally important difference (MID) values were estimated via anchor based method, while minimally detectable difference (MDC) figures were calculated by distribution based method.

Results

Criterion validity of CMYMOP was demonstrated by negative correlation between CMYMOP Profile scores and all SF-36 domain and summary scores at baseline. For responsiveness between baseline and 4^th week follow up, ES of CMYMOP Symptom 1, Activity and Profile reached the moderate change threshold (ES>0.5), while Symptom 2 and Wellbeing reached the weak change threshold (ES>0.2). None of the SF-36 scores reached the moderate change threshold, implying CMYMOP's stronger responsiveness in CM setting. At 2^nd week follow up, MID values for Symptom 1, Symptom 2, Wellbeing and Profile items were 0.894, 0.580, 0.263 and 0.516 respectively. For Activity item, MDC figure of 0.808 was adopted to estimate MID.

Conclusions

The findings support the validity and responsiveness of CMYMOP for capturing patient centred clinical changes within 2 weeks in a CM clinical setting. Further researches are warranted (1) to estimate Activity item MID, (2) to assess the test-retest reliability of CMYMOP, and (3) to perform further MID evaluation using multiple, item specific anchor questions.

Measures of self-perceived well-being

As people lead longer and generally healthier lives, aspirations and expectations of health care extend to include well-being and enhanced quality of life. Several measurement scales exist to evaluate how well health care reaches these goals. However, the definitions of well-being or quality of life remain open to considerable debate, which complicates the design, validation, and subsequent choice of an appropriate measurement.

OBJECTIVE

This article reviews nine measures of psychological well-being, tracing their origins in alternative conceptual approaches to defining well-being. It compares their psychometric properties and suggests how they may be used.

METHODS

The review covers the Life Satisfaction Index, the Bradburn Affect Balance Scale, single-item measures, the Philadelphia Morale scale, the General Well-Being Schedule, the Satisfaction With Life scale, the Positive and Negative Affect Scale, the World Health Organization 5-item well-being index, and the Ryff's scales of psychological well-being.

RESULTS

Scales range in size from a single item to 22; levels of reliability and validity range from good to excellent, although for some of the newer scales we lack information on some forms of validity.

CONCLUSION

Measures exist to assess several conceptions of psychological well-being. Most instruments perform adequately for survey research, but we know less about their adequacy for use in evaluating health care interventions. There remains active debate over how adequately the questions included portray the theoretical definition of well-being on which they are based.

Who gets the disability grant in South Africa? An analysis of the characteristics of recipients in urban and rural areas

BACKGROUND

This study was to establish whether there was a difference in the characteristics of people who received a disability grant and those who did not in rural and urban samples of isiXhosa-speaking people with disability in South Africa.

SAMPLE

The sample was a convenience sample and was identified through a 'snowballing' process.

INSTRUMENTATION

A demographic survey and isiXhosa versions of the International Classification of Functioning, Disability and Health (ICF) and EQ-5D, a health-related quality of life measure were utilized.

RESULTS

The sample consisted of 244 rural and 61 urban respondents, demonstrating a preponderance of physical disabilities. The groups who received or did not receive grants were equivalent in terms of age, gender, marital status and employment status. A significantly higher proportion of rural dwellers accessed the grant. The grant holders displayed significantly more problems related to mobility and to technology and policies and services relating to mobility and transport. Those who did not receive grants reported more barriers with regard to the attitudes of health workers but not with regard to any other aspect of social support.

CONCLUSIONS AND RECOMMENDATIONS

The majority of men and women with disability identified in this study received the grant, whether or not they lived in remote rural or in urban areas. As there were few differences between the groups, it is likely that several non-grant holders might qualify if they were informed of the grant and applied. The role of medical doctors as 'gatekeepers' to the grant might need to be examined.

Outcome related to impact on daily living: preliminary validation of the ORIDL instrument

Background

The challenge of finding practical, patient-rated outcome measures is a key issue in the evaluation of health care systems and interventions. The ORIDL (Outcome in Relation to Impact on Daily Living) instrument (formerly referred to as the Glasgow Homoeopathic Hospital Outcomes Scale or GHHOS) has been developed to measure patient's views of the outcome of their care by asking about change, and relating this to impact on daily life. The aim of the present paper is to describe the background and potential uses of the ORIDL, and to report on its preliminary validation in a series of three studies in secondary and primary care.

Methods

In the first study, 105 patients attending the Glasgow Homoeopathic Hospital (GHH) were followed-up at 12 months and changes in health status were measured by the EuroQol (EQOL) and the ORIDL. In the second study, 187 new patients at the GHH were followed-up at 3, 12, and 33 months, using the ORIDL, the Short Form 12 (SF-12), and the Measure Yourself Medical Outcome Profile (MYMOP). In study three, 323 patients in primary care were followed for 1 month post-consultation using the ORIDL and MYMOP. In all 3 studies the Patient Enablement Instrument (PEI) was also used as an outcome measure.

Results

Study 1 showed substantial improvements in main complaint and well-being over 12 months using the ORIDL, with two-thirds of patients reporting improvements in daily living. These improvements were not significantly correlated with changes in serial measures of the EQOL between baseline and 12 months, but were correlated with the EQOL transitions measure. Study 2 showed step-wise improvements in ORIDL scores between 3 and 33 months, which were only weakly associated with similar changes in SF-12 scores. However, MYMOP change scores correlated well with ORIDL scores at all time points. Study 3 showed similar high correlations between ORIDL scores and MYMOP scores. In all 3 studies, ORIDL scores were also significantly correlated with PEI-outcome scores.

Conclusion

There is significant agreement between patient outcomes assessed by the ORIDL and the EQOL transition scale, the MYMOP, and the PEI-outcome instrument, suggesting that the ORIDL may be a valid and sensitive tool for measuring change in relation to impact on life.

A qualitative study of the health-related quality of life of disabled children

This qualitative study investigated what disabled children thought most important in their lives and examined how well their priorities are represented in KIDSCREEN, a generic health-related quality of life (HRQoL) instrument. Participants were a subgroup of families who had previously taken part in a study of quality of life and participation in children with cerebral palsy (CP) using KIDSCREEN. This subgroup was sampled purposively, using children's scores on KIDSCREEN and demographic characteristics. Twenty-eight children (15 males, 13 females; age range 8y 3mo-13y 5mo) and 35 parents were interviewed. Ten children were at Gross Motor Function Classification System Level I, 15 were at Levels II or III, and three were at Levels IV or V. Eleven children had unilateral spastic CP, 16 had bilateral spastic C P, and one child had dyskinetic C P. Interviews were audio-recorded and transcribed verbatim. The analysis was based on the constant comparative method and focused largely on the children's data, though the parent data were drawn upon to illuminate the children's data. Four overarching areas of HRQoL were identified: social relationships; home and school environment; self and body; and recreational activities and resources. These generally mapped well to the dimensions and items in KIDSCREEN. The precedence children gave to environmental, social, interpersonal, health, and functional concerns corresponded well with the balance of these items in KIDSCREEN. However, children had some specific priority areas that were not represented in KIDSCREEN. These included: relationships with family members other than parents; inclusion and fairness; home life and neighbourhood; pain and discomfort; environmental accommodation of needs; and recreational resources other than finances and time. We recommend that further consideration be given to inclusion of these areas in the assessment of HRQoL of disabled children.

How to summarise and report written qualitative data from patients: a method for use in cancer support care

GOALS OF WORK

The goal of this study is the determination of key themes to aid the analysis of qualitative data collected at three cancer support centres in England, using the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire.

PATIENTS AND METHODS

People with cancer who use complementary therapies experience and value a wide range of treatment effects, yet tools are urgently required to quantitatively measure these outcomes. MYCaW is an individualised questionnaire used in cancer support centres providing complementary therapies, scoring 'concerns or problems' and 'well-being' and collecting qualitative data about other major events in a patient's life and what has been most important to the patient. Content analysis on 782 MYCaW questionnaires from people at these cancer support centres was carried out. The 'concerns,' 'other things going on in their life' and 'important aspects of centre' were thematically categorised and externally validated by a focus group, and the inter-rater reliability was calculated.

MAIN RESULTS

Clinical information from a cancer patient's perspective was collected that is not measured on standard quality-of-life questionnaires; furthermore, some themes acknowledge the multi-faceted aspects of complementary and alternative medicine provision, rather than information only relating to the therapeutic intervention. Categories for qualitative MYCaW analysis have been established providing a tool for future research and/or service delivery improvement within cancer support centres such as these.

CONCLUSIONS

The established themes provide a framework to aid analysis of qualitative aspects of complementary therapy care for people with cancer, improving our understanding of how the patient's cancer experience can be aided by complementary therapies in specialised cancer centres.

Measure Yourself Concerns and Wellbeing (MYCaW): An individualised questionnaire for evaluating outcome in cancer support care that includes complementary therapies

BACKGROUND AND AIM

Descriptive and experimental evaluations of cancer support services require an outcome questionnaire that is valid, responsive to change, feasible and interpretable. This paper describes the development of such a tool.

DEVELOPMENT OF THE QUESTIONNAIRE

A validated individualised measure MYMOP was adapted and piloted in two centres, and a multidisciplinary research team used this experience to develop the new questionnaire, Measure Yourself Concerns and Wellbeing (MYCaW). MYCaW requires participants to nominate one or two concerns and, using a seven-point scale, to score these concerns and their general feeling of wellbeing. The follow-up questionnaire also includes the open question 'Reflecting on your time with this Centre, what were the most important aspects for you?' INVESTIGATING VALIDITY: During 2003 the two centres administered MYCaW to all new patients, before and after a course of treatment. Patients nominated concerns that spanned physical, emotional and psychosocial concerns. For patients completing follow-up questionnaires (n=254 at the Cavendish Centre and n=267 at the Bristol Cancer Help Centre), the mean change (S.D.) for the first concern score was 2.9 (1.63) and 1.91 (1.58) for the second concern score 2.5 (1.73)/1.77 (1.96) and for the wellbeing score 1.4 (1.8)/0.61 (1.52), respectively. The open question collected valuable extra data.

DISCUSSION

MYCaW is a questionnaire that is appropriate for the service offered, acceptable to patients, practitioners and researchers, and is responsive to change. Further validation work is planned.

First impressions in complementary practice: the importance of environment, dress and address to the therapeutic relationship

The aim of the study was to explore patients' views of the importance of environmental and social factors within a complementary and alternative medicine (CAM) practice. A cross-sectional patient survey was conducted in 37 CAM practices across nine geographical areas of the UK using a structured questionnaire. The 219 responders (response rate 59%) were 65% female. The most common treatment modalities were osteopathy and acupuncture. Patients rated telephone manner, practitioner appearance and explanatory literature as very important factors in shaping first impressions and influencing their confidence in the complementary practice. Patients' preferences for practitioner dress code were highly variable. Overall 65% preferred a white coat to casual dress. A multivariate analysis revealed that this preference was statistically significantly greater in two geographical regions and in patients over 70 years old. It was not influenced by gender or treatment modality. Further research is recommended in order to understand how the complex verbal and non-verbal communication implicit in the CAM setting may affect the therapeutic relationship.

Effectiveness of a Minimal Intervention for Stress-related mental disorders with Sick leave (MISS); study protocol of a cluster randomised controlled trial in general practice [ISRCTN43779641]

BACKGROUND

The main aims of this paper are to describe the setting and design of a Minimal Intervention in general practice for Stress-related mental disorders in patients on Sick leave (MISS), as well as to ascertain the study complies with the requirements for a cluster randomised controlled trial (RCT). The potential adverse consequences of sick leave due to Stress-related Mental Disorders (SMDs) are extensive, but often not recognised. Since most people having SMDs with sick leave consult their general practitioner (GP) at an early stage, a tailored intervention given by GPs is justified. We provide a detailed description of the MISS; that is more accurate assessment, education, advice and monitoring to treat SMDs in patients on sick leave. Our hypothesis is that the MISS will be more effective compared to the usual care, in reducing days of sick leave of these patients.

METHODS

The design is a pragmatic RCT. Randomisation is at the level of GPs. They received the MISS-training versus no training, in order to compare the MISS vs. usual care at patient level. Enrollment of patients took place after screening in the source population, that comprised 20-60 year old primary care attendees. Inclusion criteria were: moderately elevated distress levels, having a paid job and sick leave for no longer than three months. There is a one year follow up. The primary outcome measure is lasting full return to work. Reduction of SMD- symptoms is one of the secondary outcome measures. Forty-six GPs and 433 patients agreed to participate.

DISCUSSION

In our study design, attention is given to the practical application of the requirements for a pragmatic trial. The results of this cluster RCT will add to the evidence about treatment options in general practice for SMDs in patients on sick leave, and might contribute to a new and appropriate guideline. These results will be available at the end of 2006.

Exploring Outcomes Associated with Acupuncture

OBJECTIVE

The objective was to explore various methods of assessing clinically meaningful change associated with a course of acupuncture treatments.

DESIGN

The design was a prospective cohort study.

SETTING

The setting was an acupuncture clinic staffed by two physician acupuncturists in a university-affiliated family practice center.

SUBJECTS

Subjects consisted of consecutive new patients to an acupuncture clinic.

OUTCOME MEASURES

Outcomes were measured using the Medical Outcomes Study Short-Form 36 (SF-36) and Measure Your Own Medical Outcomes Profile (MYMOP). Outcomes measured were global clinical change and patient satisfaction.

RESULTS

Out of 112 eligible patients, 110 consented to the study and contributed baseline data. Of these, 80 (71%) completed the 2-month follow-up questionnaire. Mean age of study subjects was 54.5 (standard deviation, SD 17.6) years; 85 (77%) were female, and 75 (68%) were married. Mean number of acupuncture treatments during the 2-month follow-up period was 5.8 (SD, 3.5, range, 1 to 16). Statistically significant improvement from baseline to follow-up was observed with the bodily pain subscale of the SF-36 and with the MYMOP. Among those who completed the study, 52 (67%) felt that the main symptom for which they sought acupuncture had improved over the course of the study and 72 (90%) were satisfied with their treatment in the acupuncture clinic.

CONCLUSIONS

The MYMOP instrument appears to be the most useful of the four measures used to evaluate clinical outcomes associated with a course of acupuncture treatments (SF-36, MYMOP, global clinical change, and patient satisfaction). This easy-to-administer instrument appears to be sensitive to clinical change over a 2-month period among patients who sought acupuncture for a wide variety of clinical conditions.

Reducing the symptoms of lymphoedema: is there a role for aromatherapy?

Lymphoedema is a chronic and debilitating condition caused by lymphatic insufficiency, which may have serious physical, social and psychological implications for the patient. It is usually managed by a combination of strategies aimed at protecting and decongesting the oedematous limb(s) and stimulating the development of supplementary lymphatic pathways to control swelling in the long-term. However, it is not known which therapies are the most effective. Anecdotally, the addition of aromatherapy oils to massage cream may have a positive effect on symptom relief in people with cancer, although evidence is again lacking. This paper describes a randomized trial of self-massage and skin care using a cream containing aromatherapy oils versus self-massage and skin care using a cream without aromatherapy oils on objective limb volume measurements and symptom relief as measured by the Measure Yourself Medical Outcome Profile 2 (MYMOP2) in a sample of people with lymphoedema. Results indicate that self-massage and skin care significantly improved patient-identified symptom relief and wellbeing for this sample. It also slightly, but not significantly reduced limb volume. However, aromatherapy oils, carefully chosen on the basis that they should benefit this group, did not appear to influence any improvement in these measures.

Measuring changes in self-concept: a qualitative evaluation of outcome questionnaires in people having acupuncture for their chronic health problems

Background

Changes in self-concept are an important potential outcome for many interventions for people with long-term conditions. This study sought to identify and evaluate outcome questionnaires suitable for quantifying changes in self-concept in people with long-term conditions, in the context of treatment with acupuncture and Chinese medicine.

Methods

A literature search was followed by an evaluation of three questionnaires: The Wellbeing Questionnaire W-BQ12, the Patient Enablement Instrument (PEI), and the Arizona Integrative Outcome Scale (AIOS). A convenience sample of 23 people completed the questionnaires on two occasions and were interviewed about their experience and their questionnaire responses. All acupuncturists were interviewed.

Results

Changes in self-concept were common and emerged over time. The three questionnaires had different strengths and weaknesses in relation to measuring changes in self-concept. The generic AIOS had face validity and was sensitive to changes in self-concept over time, but it lacked specificity. The PEI was sensitive and specific in measuring these changes but had lower acceptability. The sensitivity of the W-BQ12 was affected by initial high scores (ceiling effect) and a shorter timescale but was acceptable and is suitable for repeated administration. The PEI and W-BQ12 questionnaires worked well in combination.

Conclusion

Changes in self-concept are important outcomes of complex interventions for people with long-term illness and their measurement requires carefully evaluated tools and long-term follow-up. The literature review and the analysis of the strengths and weaknesses of the questionnaires is a resource for other researchers. The W-BQ12 and the PEI both proved useful for this population and a larger quantitative study is planned.

FOLLOWPACE study: a prospective study on the cost-effectiveness of routine follow-up visits in patients with a pacemaker

AIMS

This communication describes the design of the FOLLOWPACE study. The overall aim of FOLLOWPACE is to quantify the cost-effectiveness of routine follow-up visits in patients with a pacemaker (PM). Specific aims are (i) to quantify the incidence of complications and the quality of life 1 year after PM implantation; (ii) to quantify which baseline characteristics measured during implantation are predictors of the occurrence of complications and quality of life after 1 year; (iii) to determine the added predictive value of follow-up measurements to improve the efficiency of follow-up and to demonstrate which follow-up measurements are redundant.

METHODS AND RESULTS

FOLLOWPACE is a prospective, observational, prognostic cohort study. About 40 PM centres in the Netherlands will participate to include about 2,500 patients. Each patient aged >or=18 receiving a PM for the first time is eligible. At baseline, i.e. time of implantation, all potential predictors of complications and quality of life after 1 year are documented. After implantation, follow-up visits will be carried out conforming with routine care, usually three in the first year. At these visits, other potential prognostic predictors will be documented. Primary outcome is the incidence of PM- or cardiac complications at 1 year. Secondary outcome parameters are quality of life and costs after 1 year.

CONCLUSION

This study will lead to definition of a more efficient routine follow-up schedule for patients with a PM, aiming to reduce time and energy while preserving the safety of pacing therapy and the prognosis of the patient. The study will ultimately provide evidence-based guidelines for PM follow-up including knowledge of the responsibilities of cardiologists, technicians, and representatives of PM manufacturers.

Quality of Life in Patients with Thalassemia Intermedia Compared to Thalassemia Major

The impact of thalassemia major and thalassemia intermedia and their associated complications on quality of life (QOL) is largely unknown. Determining the degree of health impairment as perceived by the patient is essential information needed to recommend suitable therapy. The objective of this study was to evaluate QOL in transfusion-independent patients with thalassemia (non-Tx) compared with that in transfused patients (Tx) and to identify the factors that affect QOL in thalassemia. A convenient sample of 48 thalassemia patients (29 Tx and 19 non-Tx) with mean age of 14.6 years (SD = 7.5 years) were selected during a comprehensive visit to complete a Dartmouth Primary Care Cooperative Information Chart System (COOP) questionnaire. Patients rated QOL from excellent (1) to poor (5) on five dimensions of health status. Scores of 4 or 5 represent major limitations. These results were augmented by a brief medical history and chart review. Forty-one percent of Tx patients and 47% of non-Tx patients reported severe impairments in 1-6 and 1-2 domains, respectively. The most commonly reported affected domains were feelings such as anxiety, depression, and concern of overall health status or indications of recent deterioration in health. In contrast with previous beliefs, transfusion-independent thalassemia patients also suffer serious impairment in QOL. Presented data suggest that all patients with thalassemia undergo QOL assessment so that interventions focused on affected domains can be implemented.

Frequent attenders in general practice: problem solving treatment provided by nurses [ISRCTN51021015]

BACKGROUND

There is a need for assistance from primary care mental health workers in general practice in the Netherlands. General practitioners (GPs) experience an overload of frequent attenders suffering from psychological problems. Problem Solving Treatment (PST) is a brief psychological treatment tailored for use in a primary care setting. PST is provided by nurses, and earlier research has shown that it is a treatment at least as effective as usual care. However, research outcomes are not totally satisfying. This protocol describes a randomized clinical trial on the effectiveness of PST provided by nurses for patients in general practice. The results of this study, which currently being carried out, will be presented as soon as they are available.

METHODS/DESIGN

This study protocol describes the design of a randomized controlled trial to investigate the effectiveness and cost-effectiveness of PST and usual care compared to usual care only. Patients, 18 years and older, who present psychological problems and are frequent attenders in general practice are recruited by the research assistant. The participants receive questionnaires at baseline, after the intervention, and again after 3 months and 9 months. Primary outcome is the reduction of symptoms, and other outcomes measured are improvement in problem solving skills, psychological and physical well being, daily functioning, social support, coping styles, problem evaluation and health care utilization.

DISCUSSION

Our results may either confirm that PST in primary care is an effective way of dealing with emotional disorders and a promising addition to the primary care in the UK and USA, or may question this assumption. This trial will allow an evaluation of the effects of PST in practical circumstances and in a rather heterogeneous group of primary care patients. This study delivers scientific support for this use and therefore indications for optimal treatment and referral.

A narrative review shows the unvalidated use of self-report questionnaires for individual medication as outcome measures

OBJECTIVE

Accurate individualized data on drug consumption is required for a number of purposes. While electronic medication event monitoring is the best objective measure available, self-report tools would be a useful alternative in certain situations. We searched for validated self-completion questionnaires suitable for measuring change in medication.

METHODS

A systematic search of the English language literature since 1980, and a narrative literature review.

RESULTS

Few articles described the development or use of self-report methods to measure change in medication over time. We found no questionnaire that was commonly used for this purpose, nor one that had been evaluated and published. Considerable work has been undertaken to develop questionnaires or diaries for individual projects, but because these tools and their validation are rarely published, they are not available for other researchers to use, and comparison across studies is difficult. Some work has been done developing diary formats and the Medication Quantification Scale converts complex medication change data to a single numerical score.

CONCLUSION

Medication change is rarely considered as an outcome, and when it is measured, nonstandardized methods are used. More attention needs to be given to developing self-report tools and validating them across a range of criteria.